%0 Journal Article
%T Tanzanian lessons in using non-physician clinicians to scale up comprehensive emergency obstetric care in remote and rural areas
%A Angelo S Nyamtema
%A Senga K Pemba
%A Godfrey Mbaruku
%A Fulgence D Rutasha
%A Jos van Roosmalen
%J Human Resources for Health
%D 2011
%I BioMed Central
%R 10.1186/1478-4491-9-28
%X Competency-based curricula for assistant medical officers' (AMOs) training in CEmOC, and for nurses, midwives and clinical officers in anaesthesia and operation theatre etiquette were developed and implemented in Ifakara, Tanzania. The required key competencies were identified, taught and objectively assessed. The training involved hands-on sessions, lectures and discussions. Participants were purposely selected in teams from remote health centres where CEmOC services were planned. Monthly supportive supervision after graduation was carried out in the upgraded health centresA total of 43 care providers from 12 health centres located in 11 rural districts in Tanzania and 2 from Somalia were trained from June 2009 to April 2010. Of these 14 were AMOs trained in CEmOC and 31 nurse-midwives and clinical officers trained in anaesthesia. During training, participants performed 278 major obstetric surgeries, 141 manual removal of placenta and evacuation of incomplete and septic abortions, and 1161 anaesthetic procedures under supervision. The first 8 months after introduction of CEmOC services in 3 health centres resulted in 179 caesarean sections, a remarkable increase of institutional deliveries by up to 300%, decreased fresh stillbirth rate (OR: 0.4; 95% CI: 0.1-1.7) and reduced obstetric referrals (OR: 0.2; 95% CI: 0.1-0.4)). There were two maternal deaths, both arriving in a moribund condition.Tanzanian AMOs, clinical officers, and nurse-midwives can be trained as a team, in a three-month course, to provide effective CEmOC and anaesthesia in remote health centres.In Tanzania, 47% of pregnant women deliver in health facilities and only 46% of deliveries are assisted by skilled personnel [1,2]. The met need for emergency obstetric care, at 15-30%, and the caesarean section rate (CSR) of 3% are still below ideal levels and constitute the lowest rates in the world [1,3]. The majority of these health facility deliveries and caesarean sections are for women in urban areas,
%U http://www.human-resources-health.com/content/9/1/28